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Meta-Analysis
. 2013 May;15(5):337-44.
doi: 10.1111/j.1477-2574.2012.00609.x. Epub 2012 Nov 30.

To drain or not to drain: a cumulative meta-analysis of the use of routine abdominal drains after pancreatic resection

Aart A van der Wilt  1 , Mariëlle M E Coolsen, Ignace H J T de Hingh, Gert Jan van der Wilt, Hans Groenewoud, Cornelis H C Dejong, Ronald M van Dam
Affiliations
Meta-Analysis

To drain or not to drain: a cumulative meta-analysis of the use of routine abdominal drains after pancreatic resection

Aart A van der Wilt et al. HPB (Oxford). 2013 May.

Abstract

Background: To warrant the adoption or rejection of health care interventions in daily practice, it is important to establish the point at which the available evidence is considered sufficiently conclusive. This process must avoid bias resulting from multiple testing and take account of heterogeneity across studies. The present paper addresses the issue of whether the available evidence may be considered sufficiently conclusive to continue or discontinue the current practice of postoperative abdominal drainage after pancreatic resection.

Methods: A systematic review was conducted of randomized and non-randomized studies comparing outcomes after routine intra-abdominal drainage with those after no drainage after pancreatic resection. Studies were retrieved from the PubMed, Cochrane Central Trial Register and EMBASE databases and meta-analysed cumulatively, adjusting for multiple testing and heterogeneity using the iterated logarithm method.

Results: Three reports, describing, respectively, one randomized and two non-randomized studies with a comparative design, met the inclusion criteria predefined for primary studies reporting on drain management and complications after pancreatic resection. These studies included 89, 179 and 226 patients, respectively. The absolute differences in rates of postoperative complications in these studies were -6.4%, -9.5% and -6.3%, respectively, in favour of the no-drain groups. The cumulative risk difference in major complications, adjusted for multiple testing and heterogeneity, was -7.8%, with a 95% confidence interval of -20.2% to 4.7% (P = 0.214).

Conclusions: The routine use of abdominal drains after pancreatic resection may result in a higher risk for major complications, but the evidence is inconclusive.

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Figures

Figure 1
Figure 1
Flowchart showing the numbers of studies retrieved from the literature databases and the selection of studies according to inclusion and exclusion criteria
Figure 2
Figure 2
Cumulative random-effects meta-analysis using the law of iterated logarithm of three studies of routine postoperative drainage after pancreatic resection, showing risk differences and 95% confidence intervals
Figure 3
Figure 3
Cumulative meta-analysis of outcomes of routine postoperative drainage after pancreatic resection showing cumulative Z-statistics for the effect of omitting drainage on the occurrence of major postoperative complications. Traditional cumulative Z-statistics and Z-statistics are adjusted for multiple testing and heterogeneity. LIL, law of iterated logarithm
See this image and copyright information in PMC

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